HEPARINOID ANTICOAGULATION AND TOPICAL FIBRIN SEALANT IN HEPARIN-INDUCED THROMBOCYTOPENIA

The development of heparin-induced thrombocytopenia in patients who re quire systemic anticoagulation for cardiac and vascular operations pos es a therapeutic dilemma because no alternative anticoagulants are gen erally available. Heparinoid (Org 10172) has been used as an alternati ve anticoagulant under protocol or on a compassionate use basis, and h as recently been approved by the Food and Drug Administration. There i s, however, no heparinoid antagonist to reverse the anticoagulation. T his report describes the combined use of heparinoid anticoagulation an d adjunctive fibrin sealant for topical hemostasis in a patient with h eparin-induced thrombocytopenia. Recommendations for perioperative mon itoring of heparinoid anticoagulation are provided. (C) 1997 by The So ciety of Thoracic Surgeons.